Keloid Scars: Why Do They Keep Growing and Recurring? We’ve Summarized the Basics of Treatment

A keloid is a somewhat special scar that forms over a healed wound, spreading beyond the boundaries of the original wound to healthy skin. Unlike typical scars that fade over time, keloids do not go away on their own. In fact, if left untreated, they can grow larger, become itchy, or cause pain. Therefore, the realistic goal of keloid treatment is not to 'completely eliminate' it, but rather to reduce its size, soothe symptoms, and prevent it from growing again.

Let us clarify one thing first. Keloids cannot be easily resolved by surgical removal alone. In fact, simple excision is known to have a recurrence rate of 45% to 100%. Therefore, modern treatments prioritize an approach that combines multiple methods to suppress the excessive activity of the tissue rather than just cutting it out. At Gangnam Onlif Clinic, keloids are managed from this perspective of 'suppression and care.'

🔍 Keloid vs. Hypertrophic Scar: What is the difference?

Both are raised scars, so they are easy to confuse. However, distinguishing between them is crucial because their treatment directions are completely different.

The biggest difference lies in the boundary. A keloid extends beyond the original wound boundary and spreads to normal skin. On the other hand, a hypertrophic scar stays strictly within the boundaries of the original wound and may gradually subside on its own after 1 to 2 years.

If your scar grows larger, itchier, and redder over time, it is highly likely to be a keloid. However, it is difficult to judge by sight alone since the activity of the tissue must also be evaluated, so getting a proper diagnosis is the most accurate way to confirm.

📌 Key Summary: If it spreads beyond the wound boundary and does not disappear on its own, it is likely a keloid; if it stays within the boundary and improves over time, it is likely a hypertrophic scar.

🧬 Why Do Keloids Form?

When the skin repairs a wound, it produces a protein called collagen. The problem with keloids is that this collagen accumulates excessively beyond what is needed. It is as if the tissue keeps growing because the brakes have failed.

Several risk factors overlap in this process.

• Skin Tension: They frequently develop and recur in areas where the skin is tightly stretched, such as the sternum (center of the chest), shoulders, and upper back.

• Skin Type: Darker skin tones (Fitzpatrick types IV to VI) tend to have a higher incidence rate.

• Family History & Age: They are most common in people aged 10 to 30, and having a family member with keloids increases the risk.

• Irritation: Piercings, tattoos, acne inflammation, and unnecessary surgeries can act as triggers.

For reference, the prevalence varies widely from about 0.09% to 16% depending on ethnicity. It is reported to be roughly 5 to 15 times higher in Black, Asian, and Hispanic populations compared to Caucasians.

In South Korea, the BCG vaccination scar often serves as a helpful clue. If the vaccination mark you received as a child swelled up exceptionally large, you might suspect a genetic predisposition to keloids. Of course, this is only a reference signal, not a definitive diagnosis.

📌 Key Summary: The fundamental cause of keloids is the overgrowth of collagen, and risk is heightened by high-tension areas, dark skin, family history, and skin irritation.

💉 Keloid Treatment: What Methods Are Available?

Rather than a single treatment, combination therapy using multiple methods is the standard for keloids. The combination varies depending on the location, size, and individual's constitution. The representative methods are as follows:

Intralesional Steroid Injection

This is the most widely used first-line treatment. An ingredient called triamcinolone acetonide is injected directly into the scar to suppress the overgrown tissue. It is usually repeated at 3-to-4-week intervals, with response rates reported to be between 50% and 100% in literature. However, because it can cause side effects like recurrence or skin thinning, careful control of the concentration and cycle is crucial.

Combination Drug Injections

When steroids alone produce a weak response or to minimize side effects, other medications are used in combination. **5-Fluorouracil (5-FU)** is used as an alternative that inhibits the proliferation of tissue-forming cells, thereby reducing the side effect of skin atrophy. Other options mentioned as combination injections include bleomycin and verapamil, which regulates calcium channels.

Laser Therapy

**Pulsed Dye Laser (PDL)** is used to improve redness and vascular erythema in keloids, while fractional lasers help refine the surface texture or allow medications to penetrate better. Typically, lasers are used in combination with other treatments rather than as a standalone method.

Cryotherapy

This method involves freezing and destroying overgrown tissue using liquid nitrogen. While its efficacy increases when combined with steroid injections, caution is required for darker skin tones due to the risk of hypopigmentation (skin lightening) side effects.

Silicone Gel & Silicone Sheets

This is a non-invasive, needle-free auxiliary and preventive method. It only becomes meaningful when applied consistently for at least 12 hours a day for a minimum of 2 to 3 months. Using it only briefly makes it difficult to expect any effect.

Compression Therapy

Particularly for earlobe keloids, wearing compression earrings for several months after surgical excision is key to preventing recurrence. For burn scars, compression garments are also utilized.

Post-Surgical Radiation Therapy

Combining surgical excision with radiation therapy within 24 to 72 hours post-surgery is known to reduce the recurrence rate to under 10%. However, this approach must be taken with caution for areas near sensitive organs—such as the thyroid, breasts, or gonads—as well as for children, adolescents, and pregnant women.

📌 Key Summary: The basic framework of keloid treatment relies on steroid injections as the core, combined with silicone, compression, lasers, or cryotherapy tailored to the individual's condition.

🏥 How Does Onlif Manage Keloids?

Rather than surgical incisions using a scalpel, Onlif Clinic prioritizes a non-surgical dermatological approach to suppress tissue activity. This is because keloids are scars that cannot be resolved merely by cutting them out.

First, we diagnose the activity status of the scar to determine whether it is actively growing or in a stable state. Next, we use lasers to relieve tissue adhesion, inject therapeutic agents directly into the lesion, and, if necessary, apply compression therapy to suppress overgrowth.

Keloid care is a concept of flexible management based on activity rather than ending after a fixed number of sessions. Initially, we usually recommend at least 3 to 6 treatments at 3-to-4-week intervals, and even after stabilization, we continue management to monitor for potential recurrence.

Onlif employs a specialized physician system where doctors focus on procedures they excel at, and scars are mapped out individually through 1:1 analysis. Reflecting our philosophy, "Because you are precious, we do not change you," we aim for natural recovery and stabilization instead of excessive irritation.

📌 Key Summary: Based on activity diagnosis, Onlif prioritizes non-surgical management combining lasers, intralesional injections, and compression therapy to suppress recurrence and worsening.

🛡️ Why Prevention Is the Best Cure for Keloids

Keloids are not a matter of a complete cure but are closer to a management concept. Therefore, if you suspect you have the predisposition, the wisest approach is to avoid creating wounds on your skin in the first place.

• Avoid piercings, tattoos, and unnecessary surgeries that are not absolutely essential.

• Treat acne inflammation before it leaves scars.

• If a wound occurs, manage it early with products like silicone sheets or gels.

• If you have warning signs like a family history or a prominent BCG scar, seek a consultation in advance.

One reassuring fact is that keloids are non-contagious, benign scars that extremely rarely turn into cancer. Rather than being fearful, maintaining a consistent management routine is what truly matters.

📌 Key Summary: While keloids are benign scars, they recur frequently; thus, if you have the predisposition, preventing unnecessary skin irritation is the best course of action.

❓ Frequently Asked Questions (FAQ)

Can keloids be completely cured, or do they require lifelong management?

Rather than complete elimination, the realistic goal is to reduce size, alleviate symptoms, and prevent recurrence. Due to genetic factors, it is safer to continue regular check-ups even after the scar stabilizes.

Why do they grow back after being cut out surgically?

When keloids undergo simple surgical excision, the recurrence rate is exceptionally high at 45% to 100%, and they sometimes grow back even larger. Therefore, priority is given to approaches that suppress the excessive activity of the tissue, such as injections, compression, and lasers.

How many times do I need to get steroid injections?

They are usually repeated at intervals of 3 to 4 weeks, and depending on the condition and response, 3 to 6 or more sessions may be required initially. Since pain can be a concern, treatments are carried out in a way that minimizes discomfort during the actual procedure.

Can I know in advance if I have a keloid predisposition?

You can suspect it if you have a family history or if past wounds have swelled up unusually large. In Korea, whether a BCG vaccination scar left a large mark is used as a reference signal, but a formal medical diagnosis is required for confirmation.

Which is better, silicone sheets or silicone gel?

Both are non-invasive auxiliary methods, and consistency is more important than the type of product. It must be used continuously for at least 12 hours a day for at least 2 to 3 months to be effective. For areas where sheets are hard to apply, gel may be more convenient.

My keloid is itchy and painful. Is this a sign of it worsening?

Itching, pain, and redness can be signals that the keloid is currently active. If you feel that the scar is gradually growing, it is recommended to get its activity status checked instead of leaving it unattended.

Are scar ointments effective for keloids?

While they may provide minor support for typical scars, it is difficult to reverse an already established keloid with ointments alone. It is more realistic to view them as tools for early preventive care, such as alongside silicone products.